Provider Demographics
NPI:1386815124
Name:ANDREWS, WILLAIM BAILEY (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:WILLAIM
Middle Name:BAILEY
Last Name:ANDREWS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-2353
Mailing Address - Country:US
Mailing Address - Phone:814-726-4924
Mailing Address - Fax:
Practice Address - Street 1:200 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2353
Practice Address - Country:US
Practice Address - Phone:814-726-4924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5646200001Medicare NSC
PAGA280704Medicare PIN